Pharmacological therapies Flashcards
(40 cards)
What drugs are used to treat bipolar?
Lithium
Anti-convulsants: s. valproate, carbamazepine
Anti-psychotics (in acute mania)
Patients on lithium need to be monitored, what for and why?
- renal function: Li is excreted by kidneys so they need to be working well, monitor U+E, creatinine
- Thyroid function: Li can lead to hypothyroid
What are some side effects of lithium?
LITHIUM
Leukocytosis Insipidus Tremors Hypothyroidism Increased Urine Mums beware (teratogenic)
What are some features of lithium toxicity?
Blurred vision Coarse tremor Muscle weakness Ataxia Hyper-reflexia Circulatory failure Seizures Coma
List some tricyclic antidepressants?
How do they work?
Amitriptyline
Imipramine
Blocks reuptake of noradrenaline and serotonin (so there’s more around!)Affects muscarinic and histamine receptors
Side effects of TCAs? What causes them?
Anti-cholinergic (blockage of muscarinic receptors)
- dry eyes, mouth
- blurred vision
- constipation
- urinary retention
Others:
- drowsiness
- arrhythmia
List some SSRIs?
How do they work? Where in brain?
Citalopram
Sertraline
Fluoxetine
Downregulate number of serotonin receptors in pre-frontal cortex
More seratonin floating around in synapse, so more effect
Side effects of SSRIs?
Is a stimulant so can mean that patient now has motivation to take own life
GI: nausea, anorexia, diarrhoea
Insomnia, restlessness
List some SNRIs?
How do they work?
Duloxetine
Venlafaxine
Inhibit reuptake of serotonin and noradrenaline
What does MAO stand for?
List some MAOs?
How do they work?
Monoamine oxidase inhibitors
Isocarboxazid
Inhibit monoamine oxidase enzyme, so there’s less breakdown of things like serotonin and noradrenaline
What’s a serious problem that’s caused by some anti-depressants?
Serotonin syndrome
Caused by MAOs, SSRIs, SNRIs. If taken at high doses
Increased serotenergic activity in the CNS
Features of serotonin syndrome?
Triad: CAN
- Cognitive impairment: agitation, confusion, delirium
- Autonomic: shivering, sweating
- Neuromuscular dysfunction: akathasia, clonus, tremor
Management of serotonin syndrome?
Stop drug
Supportive
Benzos
5HT (serotonin) block, called chlorpormazine
List some typical and atypical anti-psychotics?
Typical:
- Chlorpromazine
- Haloperidol
Atypical:
- olanzapine
- aripiprazole
- risperidone
- clozapine
How do the typical anti-psychotics work?
They block the action of dopamine (at differing strengths)
What are the side effects of the typical anti-psychotics?
Parkinsonism (due to dopamine being blocked)
- stiffness, tremor, stooped
Drowsiness, apathy
Extrapyramidal:
- akathasia
- tardive dyskinesia
- dystonia
- torticollis
Which typical anti-psychotic is good for psychiatric emergencies?
Haloperidol
What is:
- akathasia
- tardive dyskinesia
- dystonia
- torticollis
Akathasia: restlessness
T. dyskinesia: rhythmic involuntary movements of face, tongue, etc.
Dystonia: spasms of neck, jaw, extremities
Torticollis: holding neck in abnormal position
How do the atypical anti-psychotics work?
Block dopamine, but to a lesser extent
Also block serotonin and others
Clozapine works on different brain receptors
Side effects of the atypical anti-psychotics?
Similar to typical, but less so.
And no parkinsonism
Can still get akathasia and tardive dyskinesia
Weight gain Hyperglycaemia + diabetes Palpitations (long QT, arrythmias) Gynaecomastia Drowsy, n+v, constipation
Which atypical anti-psychotic is good for:
- younger patients
- older patients
- patients who also have mood problems
- aggressive patients
- treatment resistant schiz.
- Aripiprazole
- Risperidone
- Olanzapine
- Risperidone
- Clozapine
What do you need to look out for in a patient taking clozapine?
Agranulocytosis
Severe leukopenia, most commonly neutropenia
They’re at high risk of severe infection
Which anti-psychotic has hypersalivation as a side effect?
Clozapine
What is neuroleptic malignant syndrome?
A condition that develops after starting an antipsychotic or increasing the dose of one
Very serious and can be life threatening
Caused by dopamine blockade
